It has come up several times in the Patients Rising Concierge that veterans, or the family members of veterans, need help understanding VA healthcare. We’ve put together this basic 101-type introduction to VA healthcare that we hope helps make things clearer.
The Department of Veterans Affairs (VA) offers veterans the option of enrolling in VA health care. VA healthcare is free if the illness or injury stem from the veteran’s military service. Some other free services may also be offered under the VA plan.
Veteran’s health benefits cover the following services:
- Preventive care
- Health exams
- Health education
- Counseling for genetic disorders
- Inpatient care
- Medical treatments
- Acute care, such as for a severe illness or injury post-surgery
- Specialized care
- Urgent and emergency care
Care provided at care locations that contract with the VA will be covered, including minor illness-related visit to a health clinic or something more severe such as a cast or wound care at an urgent care clinic.
Emergency care at a non-VA clinic or hospital may or may not be covered. Additional information can be found here.
Other Covered Services:
- Mental health services
- Assisted living and home health care
- Prescriptions provided by a VA doctor
- Routine eye exams and preventive tests
- Health benefits such as dental care may not be available for all veterans and depends on:
- Priority group (more about priority groups below)
- Advice of the VA primary care provider
- Medical standards for treating the individual’s health conditions
What are the VA Priority Groups?
The VA assigns veterans signing up to receive care into eight priority groups, which can impact how quickly an individual receives care and what their out-of-pocket cost will be for the care they receive. The following factors influence placement in a priority group:
- History of military service
- Disability rating
- Income level
- If the veteran also qualifies for Medicaid
- Supplementary benefits that the individual receives, such as VA pension benefits
Higher income and absence of a service-related disability would place a veteran in the lowest priority group; service-related disability would qualify a veteran for the highest priority group. For those who qualify for more than one priority group, they will be placed in the highest priority group.
There are two additional VA Priority Groups;
Group 7 for those whose annual income is below the geographically adjusted income limits (GMT) for where you live, and who agree to pay copays.
Group 8 for those whose annual income is above VA income limits and geographically adjusted income limits for where you live, and who agree to pay copays.
Can You be Enrolled in VA Health Care and Other Insurance?
Yes, you can. It is important, however, to share this information with the VA because non-service-related illnesses or injuries will be billed to the private plan or Medicare supplemental health insurance plan that the veteran may be enrolled in. The veteran may owe copay for non-service-related services not covered by the non-VA plan.
- VA health care charges could count toward the private insurance’s deductible
- If the private insurance pays VA for a veteran’s non-service-related care, it could offset the veteran’s VA copay
Dependent Care for Veterans
If dependents of veterans are not covered under the VA health plan, private health insurance or the Health Insurance Marketplace are available options. Low-cost options include Medicaid and Children’s Health Insurance Program.
Veterans who have separated from active duty could apply for Tricare coverage that can cover them and their families for a temporary period.
- Veteran’s Affairs Concierge for Care Program: https://www.veteranaid.org/blog/concierge-for-care-program-for-veterans/#:~:text=The%20United%20States%20Department%20of%20Veterans%20Affairs%20%28VA%29,healthcare%20programs%20as%20efficiently%20and%20quickly%20as%20possible.
- Balancing VA care and other forms of health insurance: https://www.va.gov/health-care/about-va-health-benefits/va-health-care-and-other-insurance/.
- Medicare Part B enrollment and VA benefits: https://www.medicareinteractive.org/get-answers/coordinating-medicare-with-other-types-of-insurance/veterans-affairs-va-benefits-and-medicare/making-part-b-enrollment-decisions-with-va-benefits.
Patients Rising acknowledges the important contributions of Surabhi Dangi-Garimella, Ph.D. in this article. Improving patient access is our mission and we are happy to utilize a variety of experts to carry that out.